We thank Dr. Krishnakumar for the interest in our study [1] and for his constructive comments. [2]

In our study we paid primary attention to the roots involved rather than the level of disc involved. Hence, all the 10 patients who received injections of two nerve roots do not necessarily mean that they had a two-level (disc) involvement. For example, L4-5 disc protrusion can produce radicular pain of L4, L5 and also S1. [3] In our cases, these 10 patients included both two-level disc protrusion and single-level but had entrapment of two roots determined by neurological examination. Again, all our selected patients had unilateral symptom though we did not mention it.

We have mentioned in the abstract that the same injection was repeated if at any point of time patient had a pain of >5 VAS. Manchikanti et al., [4] state that epidural injections should be repeated only as necessary according to medical necessity criteria, and it is suggested that these be limited to a maximum of four to six times per year. We intended to establish or refute the possibility of transforaminal epidural steroid (TFES) injections as a mode of treatment in disc protrusion cases. Exact dosage (number of interventions needed) of treatment is still controversial. Therefore, single injection per patient was not imperative to us; rather we wanted to see whether these patients could be better managed with this newer method of therapy.

We admit that more stringent patient selection criteria could have been adopted, but before the study started it was not known to us that symptoms of six months' duration would have better prognosis.

Pain is always uncomfortable but even after one year none of the patients opted for surgery or for a repeat injection. RM (Roland-Morris) score was much improved at one year. Therefore although it does not reach to the level of our expectation, the relief was not negligible.

Spine Patient Outcomes Research Trial (SPORT) is not very relevant to our study. The non-operative treatment options in the SPORT study are nonspecific and to some extent vague. Surgeons could choose from multiple treatment options and many possible medications. Hence, they were unable to make any specific comment regarding the effects of TFES injection per se.

To incorporate MSU classification of lumbar disc herniations is indeed an excellent idea. This time we did not have the option as our study started before the article on MSU classification was published.